Provider Demographics
NPI:1821563370
Name:KIM, RYAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 JOHN HUMPHREY DR STE 1E
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2897
Mailing Address - Country:US
Mailing Address - Phone:708-671-1500
Mailing Address - Fax:708-671-1535
Practice Address - Street 1:14400 JOHN HUMPHREY DR STE 1E
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2897
Practice Address - Country:US
Practice Address - Phone:708-671-1500
Practice Address - Fax:708-671-1535
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily